CAPA News Nov Dec 2012 by CA Academy of PAs

News

Official Publication of the California Academy of Physician Assistants

November/December 2012

\The Magazine

CURES at CAPA: Over 200 PAs Sign Up! by Jeremy Adler, MS, PA-C, CAPA Vice President

California Department of Justice

200 CURES applications signed, sealed and delivered

The key program at the California Academy of Physician Assistants 36th Annual Conference was CURES at CAPA. The goal of this program was to increase awareness of the importance of California’s Prescription Drug Monitoring Program (PDMP) and reduce barriers that have limited PAs from registering for access. A key barrier to becoming an authorized user of CURES is the need for notarized documents. CAPA provided onsite notary services at no additional cost to conference attendees to encourage

registering with CURES. Over 200 PAs attending the conference took advantage of this service and were able to have completed registration material sent to the State. California’s PDMP is called the Controlled Substance Utilization and Evaluation System (CURES) and Patient Activity Reports (PARs) can be generated listing all controlled substance prescriptions that patients have filled in California over the prior 12 months. It is the belief of many clinicians, the Centers for Disease Control and the Office of National Drug Control Policy at the White House that the routine use of PDMP information will lead to more appropriate controlled substance prescribing and aid in the minimization of abuse, misuse and diversion of these substances. Improving the appropriateness of controlled substance prescribing should reduce the potentially lethal harms that have afflicted our communities. Most clinicians understand the value of this information, but the application process requires having documents notarized. The act of obtaining notarized documents results in barriers of both time and money. Consequently, many PAs have delayed completing their registration material. As a service to its membership, CAPA aimed to remove the notary barrier by having two onsite notaries most

days of the conference. CEP America generously sponsored the Cyber Café which allowed PAs to complete the online portion of the application and Student Ambassadors helped guide PAs through the whole process. After the documents were notarized, CAPA provided a pre-addressed, stamped envelope to ensure the documents made their way to the CURES program. The feedback from conference attendees was overwhelmingly positive. Although it came as a shock to some, many PAs were aware of budgetary problems threatening CURES. At a time when it appears the data contained within the CURES program is a key component to battling prescription drug abuse and diversion, the CURES program is currently under severe budgetary restrictions. Without identifying a source of funds for the operation of the program, it is possible the whole program will be terminated as early as next year. As I write this article, there is a statement on the website for CURES (http://oag.ca.gov/curespdmp (Accessed 10/22/12)) which states:“The California Department of Justice cannot respond to telephone inquiries or emails to the CURES/ PDMP Program due to budgetrelated resourcing issues. We regret the inconvenience.” Continued on page 3

News

At The Table

Editor Gaye Breyman, CAE Managing Editor Denise Werner Proofreaders Kimberly Dickerson Coryn Kulesza

Editorial Board Jeremy A. Adler, MS, PA-C Adam Marks, MPA, PA-C Bob Miller, PA-C Larry Rosen, PA-C Michael Scarano, Jr., Esq.

CAPA Board Of Directors President Adam Marks, MPA, PA-C presidentelect@capanet.org Vice President Jeremy A. Adler, MS, PA-C vicepresident@capanet.org Secretary Joy Dugan, PA-C, MSPH secretary@capanet.org Treasurer Bob Miller, PA-C treasurer@capanet.org Directors-At-Large Anthony Gauthier, PA-C, ATC diranthony@capanet.org

George Wright, PA-C, Assembly Member Das Williams and Peter Wright at a CAPP reception on October 15, 2012 at the Victoria Care Center in Ventura.

CAPA Public Policy Director, Teresa Anderson, MPH addresses the Physician Assistant Committee on October 29 to address PA workforce issues. Video of the October PAC meeting can be seen on line at http:// www.youtube.com/watch?v=K0qMHCWxDgE&feature=youtu.be

Roy Guizado, MS, PA-C dirroy@capanet.org Matthew Keane, PA-C dirmatthew@capanet.org Greg Mennie, PA-C, MSed dirgreg@capanet.org Larry Rosen, PA-C dirlarry@capanet.org Student Representative Saloni Swarup, PA-S studentrep@capanet.org

The CAPA News is the official publication of the California Academy of Physician Assistants. This publication is devoted to informing physician assistants to enable them to better serve the public health and welfare. The publisher assumes no responsibility for unsolicited material. Letters to the editor are encouraged; the publisher reserves the right to publish, in whole or in part, all letters received. Byline articles express the opinion of the author and do not necessarily reflect the views or policies of the California Academy of Physician Assistants.

The CAPA office is located at: 2318 S. Fairview St. Santa Ana, CA 92704-4938 Office: (714) 427-0321 Fax: (714) 427-0324 Email: CAPA@capanet.org Internet: www.capanet.org ÂŠ2012 California Academy of Physician Assistants

CAPA NEWS

CAPA Leadership Opportunities Elections for the 2013-2014 CAPA Board of Directors and for Delegates to the AAPA House of Delegates in Boston in 2014 will be held in the Spring. If you are interested in running for office, please contact CAPA President and Nominating Committee Chair, Adam Marks, PA-C to learn more about CAPA leadership and where your experience and skills are most needed. Important Deadlines: Deadline for the CAPA office to receive Candidate Data Form for those who do not wish to go through the Nominating Committee: February 15, 2013 Deadline for the CAPA office to receive Candidate Data Form for those who wish to be reviewed/endorsed by then Nominating Committee: March 1, 2013

If you would like to learn more about running for CAPA office or serving on a CAPA Committee, please email President, Adam Marks, MPA, PA-C at president@capanet.org

CURES at CAPA: Over 200 PAs Sign Up! Continued from page 3

(schedule II-IV). The goals of the CURES program (from their website) are:

Jeremy Adler, MS, PA-C; coordinator of the CURES at CAPA project, peers over the mound of CURES registration envelopes.

As PAs, we are a key stakeholder in seeing the CURES program preserved. CAPA is committed to representing PAs in Sacramento consistent with the Academy’s mission. Given the response to the CURES at CAPA program, it remains clear that access to CURES is of vital importance to California’s PAs. The CURES program, in summary, is the product of the oldest PDMP in the country. It began in 1940 as a triplicate prescription program and has evolved into an online, real-time, searchable database that tracks more than 100 million controlled substance prescriptions

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Reduce drug trafficking and abuse of dangerous prescription medications which often results in injury or death

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Reduce direct financial losses to health care providers, hospitals and pharmacies that waste time and lose productivity when patients doctor shop to feed drug addiction or criminal activity

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Reduce lost productivity to employers, employee lost wages, and drug rehabilitation expenses

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Reduce prescriber, hospital, and pharmacy liability and increasing health care costs

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Reduce hospital emergency room visits attributed to prescription drug overdose and misuse

The clinical importance of PDMP data was highlighted in a study of Ohio Emergency Department Physicians in 2010. In this

study, ED physicians evaluated patients and determined an opioid prescription before being shown the PDMP data. Once the PDMP data was revealed to the physicians, 41% of the time the physician wanted to change their prescription. As maybe expected, 61% of the changes were either to not prescribe an opioid or prescribe fewer opioids. Interestingly, 39% of the time they felt the patient was more appropriate for the opioid and felt more opioid was indicated. The net result of the study is that PDMP data should improve patient care. Those patients who have a legitimate medical need for controlled substances should be able to have access, and those who are abusing, misusing and diverting should have their access restricted. To register for the CURES program, please visit: https://pmp. doj.ca.gov/.  1 Baehren et al. A statewide prescription monitoring program affects emergency department prescribing behaviors. Ann Emerg Med. 2010. 56(1): 1923

Inside This Issue At the Table..........................................................................2

The Fabric of the PA Profession Videos.................................13

CAPA Leadership Opportunities..............................................2

2012 Student Challenge Bowl.............................................14

Building a Bridge to Better Access, Part 1............................24

Profession Practice Videos.....................................................5

Robert Theodore Miller, PA-C Honored with Pride of the Profession Award........................15

ER Reflection......................................................................25

2012 Update: Cervical Cancer Screening Guidelines...............6

CAPA’s 36th Annual Conference - Fabric of the PA Profession.......16

Coping Mechanisms During Your Didactic Education:

Patient Protection and CAPA..................................................7

Physician Assistants for Literacy (PALs)................................18

A Current PA Student’s Perspective.......................................27

CAPA in Sacramento..............................................................8

New CME Requirements for Renewing Your California PA License!..........................................................19

Study Habits for PA Students...............................................28

The PAC Becomes a Board!....................................................9 Crayolas, Pipelines and Authentic Diversity..........................10

Controlled Substances Education Courses..............................20

CAPA Student Scholarships..................................................30

PA Means Political Action, Too!............................................11

CAPA at Napa.....................................................................21

Welcome New Members......................................................31

CAPA’s 36th Annual Conference...........................................12

The Poverty of Health Care.................................................22

Local Groups......................................................................31

Someone Asked …..............................................................4

Specialty Care for the Uninsured:

Thank You, NAAPC..............................................................26

Thank You to Our 2012 Student Ambassadors......................30

NOVEMBER/DECEMBER 2012

Someone Asked … by Bob Miller, PA-C, Professional Practice Committee Chair order home health and provide hospice care for Medicare beneficiaries. PAs may now perform a required face-to-face home health examination as a representative of the physician but the physician must sign the form. The AAPA continues to work on this Medicare issue and there are current legislative efforts to provide a fix.

ere are some of the most frequent questions coming in to the CAPA office over the last several months. These were also discussed at the recent CAPA Conference in Palm Springs.

Q. national level, Medicare A. Atallowsthe PAs to order DME. In Can PAs authorize durable medical equipment (DME)?

addition, California Senate Bill 1069*, Pavley, in 2010 included a section which clarifies DME can be authorized by a PA in California. See excerpt below: CA B&P Code, Section 3502.3. (a) … a delegation of services agreement may authorize a physician assistant to do any of the following: 1) Order durable medical equipment, subject to any limitations set forth in Section 3502 or the delegation of services agreement. Notwithstanding that authority, nothing in this paragraph shall operate to limit the ability of a third-party payer to require prior approval.

Q. is unfortunate but Medicare A. Itrestricts the PA’s ability to Can PAs order home health care?

CAPA NEWS

However, in California, the Pavley Bill - again SB 1069*, 2010 provided a section which allows PAs to care for patients receiving home health services after consulting with the supervising physician (but not for Medicare beneficiaries). See excerpt below: CA B&P Code, Section 3502.3. (a) … a delegation of services agreement may authorize a physician assistant to do any of the following: (2) For individuals receiving home health services or personal care services, after consultation with the supervising physician, approve, sign, modify, or add to a plan of treatment or plan of care. a PA perform student Q. Can athletic physicals? Pavley strikes again A. Senator with SB 1069*, 2010. Another section of this Senate Bill added the following language to the California Education Code. See excerpt below: CA Education Code, Section 49458. When a school district or a county superintendent of schools requires a physical examination as a condition of participation in an interscholastic athletic program, the physical

examination may be performed by a physician and surgeon or physician assistant practicing in compliance with Chapter 7.7 (commencing with Section 3500) of Division 2 of the Business and Professions Code. a PA authorize Q. Can California Disability? yet … we will continue to A. Not work on this issue! For now, PAs in California cannot sign/ authorize state disability insurance. This is an issue we are trying to correct. We were recently close to fixing this through legislation by having PAs added to the list of providers who may sign the EDD forms. However, that particular portion of the legislative bill was deleted in the final language. Because it is a priority, we will continue to try to obtain the appropriate legislative changes. The systems to provide aid to disabled persons are complex but here is a very brief description of a few of them: California State Disability Insurance (SDI) is administered by the Employment Development Department (EDD) and is for eligible persons to receive short-term wage replacement generally for non-work related disabilities. The program is funded by workers’ payroll deductions. California Workers’ Compensation is not the same as SDI. It is funded by employers to provide insurance for either, longterm or short-term work-

related injuries and illnesses. In a California workers’ comp situation a PA may authorize time off work for a patient not to exceed three calendar days and the PA may cosign the Doctor’s First Report. The physician determines/ authorizes a workers’ comp disability. The Federal Workers’ Compensation system does not allow PAs to diagnose and treat federal employees or provide medical evidence. The AAPA continues to work on this at the national level. Social Security Disability Insurance (SSDI) is yet another way for an eligible disabled person to obtain long-term disability. This is a federal program and the person must have earned appropriate credits paid into Social Security to qualify. The SSDI application process is cumbersome and does not

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accept medical evidence from only a nurse practitioner or PA. Such evidence would require a separate consultation with a physician or other accepted provider. In a recent report, The National Law Center on Homelessness & Poverty (NLCHP) made a clear statement regarding how to improve patient access and to facilitate a more streamlined application process. Their report recommended the following as one of the obvious steps by: “Allowing nurse practitioners, physician assistants, and licensed clinical social workers to provide diagnostic evidence of certain medical conditions would streamline the process for obtaining benefits, ensuring that eligible individuals gain access to these critical benefits in a timely manner.” 

Robert Miller, PA-C CAPA Professional Practice Committee Chair

… your host on an enlightening series of videos depicting the history of physician assistant practice in California and the evolution of the Physician Assistant Practice Act.

* If you would like to read the entire bill (or any other bill), SB 1069, Pavley, 2010 can be found on line at www.leginfo.ca.gov then “search bills.”

• PA Scope of Practice

THANK YOU

• Prescriptive Authority and Protocols • Laws and Regulations • The Surgical PA • Reimbursement Issues

For Your Generous Support of Two CAPA Conference Favorites!

Cyber Café and Ice Cream Breaks

• The New PA and the New Job

Available NOW on the CAPA Website

NOVEMBER/DECEMBER 2012

2012 Update: Cervical Cancer Screening Guidelines by Greg Mennie, PA-C, MsEd, Director -At-Large

he United States Preventive Services Task Force (USPSTF) and The American Cancer Society (ACS), The American Society for Colposcopy and Cervical Pathology (ASCCP) and The American Society for Clinical Pathology (ASCP) recently released new recommendations for cervical cancer screening. The American College of Obstetrics and Gynecology (ACOG) is currently reviewing the guidelines.

Age recommendations1,2,3: • <21 – no screening without risk factors • 21 - 65 without risk factorscytologic screening every 3 years. • 30 - 65 without risk factorscytologic and human papillomavirus (HPV) screening (co-testing) every 5 years. • 65 no screening without risk factors if screened in the past Other considerations1,2,3: • HPV vaccinated – still requires screening as above • Hysterectomy with removal of cervix and no history of CIN2+ or cervical cancer require no further screening • ASCUS – see reference 3 Unique to each of the groups in their recommendations are the following: For the USPSTF, this is a departure from their previous guidelines regarding HPV as a cotest for screening. In the past they had noted insufficient evidence for the use of HPV co-testing.

Unique to the outcome of these new guidelines, they were developed by both groups independently, but with similar results creating the current recommendations. The groups looked at length of time between Pap screens, as well as employing two different types of screening modalities: 1. Cytology = cell-collection from the cervix/endocervix or 2. Co-Testing = cytology in conjunction with Human Papillomavirus (HPV) Screening (obtained at time of Pap with cervical cells) 6

CAPA NEWS

The ACS/ASCCP/ASCP gathered evidence from multiple past trials noting superior detection rates in co-testing compared to cytology alone. Based on this evidence, they concluded that “co-testing at less frequent intervals” when compared to cytology alone was more than adequate. Thus they prefer cotesting every five years over cytology alone every three years. Recommendations for less frequent screening have been developed in the past. These recommendations have been based around the evidence that cervical cancer is not a fast growing cancer and a

large number of cervical cancers detected are in women who have had large gaps in screening or have never undergone screening prior to diagnosis. Again these new guidelines apply to women with “average-risk.” Women with HIV or prior history of risk factors should not be tested under these recommendations and may benefit from more frequent exams and testing. Some practical ideas regarding less frequent “Paps” While cervical cancer is certainly a significant disease, according to the CDC4, it is not in the top 10 cancers in Caucasians, it ranks #9 in African-Americans, and #7 in Hispanics. The top three cancers in all women are Breast, Lung, and Colorectal. While women may forego an annual Pap, women, young and old, should still have annual visits. Osteoporosis, STD, and Cholesterol screening are among a long list of integral social and health screening areas addressed during the annual female exam. The annual well-visit allows providers to counsel women on the current guidelines for screening and detection of other health issues and regardless if a Pap is performed or not, the provider should spend the time necessary addressing other critical concerns. This is nicely summed up in this quote from the ACOG update: “The well-woman visit has always been more than just a “Pap smear,” and the decreased need for cervical screening actually constitutes a minor change to an important aspect of a woman’s health care.” 

Continued on page 18

Patient Protection and CAPA by Adam Marks, MPA, PA-C, CAPA President

he Supreme Court’s recent decision upheld the majority of the Patient Protection and Affordable Care Act (PPACA) – also known as the “ACA.” California policymakers and analysts are now looking ahead to the implementation of PPACA in 2014 and beyond. Along with the individual mandate, several other provisions including: 1) dependent coverage until the age of 26, 2) no pre-existing condition exclusions or refusal based on health status, “We will continue to 3) guaranteed advocate for regulatory and renewability of coverage, 4) no lifetime or legislative changes which unreasonable annual limits, 5) coverage will enhance the ability of of preventive health services, 6) the physician assistant to health insurance provide safe, cost-effective premiums not based on conditions and medical care to the citizens comprehensive coverage, were also upheld as of California.” constitutional. However, Medicaid expansion was struck down in a 7-2 vote on the premise that it is unconstitutional coercion. Refusal to comply with the expansion could cost a state all of their federal Medicaid funding. Therefore, it is up to individual states to determine if they will expand Medicaid. These Federal provisions continue to be a driving force in legislative transformation in California health care reform. Since 2010, the California legislature has enacted several key pieces of legislation and continues to move legislation related to implementation of PPACA. Some key pieces of California legislation include:

AB 210 Maternity Services: Insurance Coverage, requires group health insurance policies to provide maternity coverage for all those insured AB 922 Office of Patient Advocate, revises OPA duties and assigns new duties consistent with the requirements set forth in the PPACA AB 1602 California Patient Protection and Affordable Care Act, establishes a Health Benefits Exchange AB 1887 and SB 277 Temporary High Risk Pool, creates PreExisting Conditions Insurance Pool AB 2345 Covering Preventive Services, requires insurers to eliminate cost-sharing for some preventive services such as pap smears, mammograms, other cancer screenings and immunizations AB 2244 Health Care Coverage, Access and Affordability for Children with Pre-Existing Conditions, requires guaranteed issue, eliminates all pre-existing condition exclusions and limits premium increases based on health status, phasing in modified community rating for children under age 19 in the individual market

Benefits Exchange SB 1088 Health Care Coverage, Dependents, requires group health, dental and vision plans to allow dependent children to continue on their parent’s coverage through the age of 26 While these are just a few of the important pieces of legislation that California has enacted to align our state with federal health care reform; there is still a great deal of work to be done. Medicare and Medicaid (Medi-Cal) remain seriously underfunded and reimbursement rates jeopardize the ability to provide care and/ or increase access to care at a time when our state is likely to see millions of previously uninsured people seeking care. As we move forward with the implementation of health care reform, CAPA is dedicated to improving access to quality, affordable, costeffective care delivered in a team-based, coordinated health care delivery system. We will continue to advocate for regulatory and legislative changes which will enhance the ability of the physician assistant to provide safe, cost-effective medical care to the citizens of California. 

SB 51 Health Care Coverage, establishes enforcement authority in California law to implement provisions of the federal Patient Protection and Affordable Care Act SB 900 California Health Benefits Exchange, established Health NOVEMBER/DECEMBER 2012

CAPA in Sacramento by Teresa Anderson, MPH, Public Policy Director

n October, CAPA members from across the state came together at the 36th Annual Conference to celebrate the Fabric of the PA Profession. Though there were many highlights throughout the Conference the video montage was extraordinary. PAs were asked where they practice and what area of medicine they practice in; students were asked what school they went to and where they see themselves practicing. The diversity and passion was incredible. Critical to strengthening and advancing the PA profession in California is the need to promote policy and legislation that is just as diverse as the profession itself. A look back at the last 2-year session reflects CAPA’s strong desire to protect and advance the profession while representing the diversity of our members. We make every effort to track bills that promote the physician assistant profession, teambased care, access to care and health systems improvement. In fact, over the past two years we have tracked more than 200 bills and supported 17 health-related resolutions. The outcome of our bill file is as follows: 43 Bills were chaptered and signed into law 18 Bills were vetoed 150 (+) Bills failed to move through the process 10 Assembly Concurrent Resolutions were chaptered 7 Senate Concurrent Resolutions were chaptered A sample of bills CAPA tracked during this legislative session: SB 233 (Pavley) Emergency Services and Care – Sponsored by CAPA Chaptered (2011) This bill clarifies existing law to explicitly permit appropriately 8

CAPA NEWS

licensed personnel to perform consultations and treatment in an emergency department if within their existing scope of practice. SB 1301 (Hernandez) Prescription Drugs: 90 Day Supply Chaptered (2012) This bill authorizes a pharmacist to dispense not more than a 90-day supply of medication pursuant to a valid prescription that specifies the initial dispensing of a lesser amount followed by periodic refills of that amount if the patient has completed an initial 30-day supply of the medication, as specified. AB 137 (Portantino) Health Care Coverage: Mammographies Chaptered (2012) Requires every individual or group policy of health insurance to provide coverage for mammography, for screening or diagnostic purposes, upon the referral by a participating nurse practitioner, participating certified nurse-midwife, participating physician assistant, or participating physician, as specified, based on medical need regardless of age. AB 389 (Mitchell) Bleeding Disorders Chaptered (2012) This bill establishes requirements for providers of blood clotting products for home use (providers) to treat hemophilia and other bleeding disorders. AB 2109 (Pan) Communicable Disease: Immunization Exemption Chaptered (2012) Requires on and after January 1, 2014, a separate form prescribed

by the Department of Public Health (DPH) to accompany a letter or affidavit to exempt a child from immunization requirements under existing law on the basis that an immunization is contrary to beliefs of the child’s parent or guardian. AB 1000 (Perea) Health Care Coverage: Cancer Treatment Vetoed (2012) This bill would have required a health plan contract or health insurance policy that provides coverage for prescription drugs and cancer chemotherapy treatment to limit enrollee outof-pocket costs for prescribed, orally administered anticancer medications. The Governor vetoed the bill citing the following in his veto message: I am returning Assembly Bill 1000 without my signature. While I support the author’s efforts to make oral chemotherapy treatments more affordable for the insured, this bill doesn’t distinguish between health plans and insurers who make these drugs available at a reasonable cost and those who do not. I am concerned about the high cost of these drugs, but I am also deeply sympathetic to the suffering of cancer patients. I will direct the Department of Managed Health Care to work with the author and stakeholders to find alternative approaches to solve this problem. Sincerely, Edmund G. Brown Jr. SB 393 (Hernandez) Medical Homes – Co-Sponsored by CAPA Vetoed (2012) This bill would have established the Patient-Centered Medical Home Act of 2012 and codified a definition for PCMH. The Governor vetoed the bill citing

the following in his veto message: I am returning Senate Bill 393 without my signature. I commend the author for trying to improve the delivery of health care by encouraging the greater use of “patient-centered medical homes.” While this concept is not new, it is still evolving. For this reason, I think more work is needed before we codify the definition contained in this bill. Sincerely, Edmund G. Brown Jr. Needless to say there were several important health care related bills

that did not make it through the legislative process. That doesn’t mean those ideas are gone forever, we are hopeful that several of them will come back in the special session or during the next legislative session. Governor Brown has called for a Special Session focused on implementing the federal reform law it will begin in December or January and run concurrently with the regular legislative session. Much opportunity lies ahead as we begin our quest to educate all the new legislators coming into office and reconnect with seasoned legislators

that have been friends to CAPA over time. As I close, I want to congratulate Dr. Richard Pan on his new position as Chair of the Assembly Health Committee and offer a quote from him as he assumes this leadership role: “With implementation of health reform, we have a tremendous opportunity to improve access to quality, affordable health care for people in California. I am excited about the opportunity to help lead this effort in the state Assembly.” 

The PAC Becomes a Board! By Bob Miller, PA-C, Chair, Professional Practice Committee

he Physician Assistant Committee (PAC) of the Medical Board of California will be repealed as of January 1, 2013 and will be renamed “It adds physician the Physician assistants to existing Assistant Board (PAB). Along with reporting requirements some other changes, for other healthcare the renaming was a result of Governor professionals found in Brown signing what is known as the 800 SB 1236 (Price) on September 14, series of the Business and 2012. In addition to Professions Code.” renaming the Board, SB 1236 also extends the operation of the Board to January 1, 2017. The Bill also affected several other Boards, Bureaus and Committees within the Department of Consumer Affairs. SB 1236 includes other changes affecting PAs in California. It adds physician assistants to existing

reporting requirements for other healthcare professionals found in what is known as the 800 series of the Business and Professions Code. These sections will now include PAs which will impose requirements in reporting occurrences of disciplinary actions, indictments, felonies and misdemeanors as well other requisite reporting. Other reporting includes actions such as certain settlements, judgments and malpractice issues. The licensee along with other entities may have the responsibility to report these actions as described in these sections. Look for further information from the Physician Assistant Committee (Board). The Bill makes changes in the composition of the Board which now includes nine members. The Board will include four PAs, one physician (for now) who is also a member of the Medical Board of California (MBC) and four public members. Upon the expiration of the term of

the physician member of the MBC, that position will be filled by a PA. A physician member of the MBC will then be appointed to serve as an ex officio non-voting member who will report actions and discussions to the MBC. The PAB will then total ten members with five PAs, four public members and the non-voting physician. The Governor appoints the licensed members and two public members. The Senate Rules Committee and the Speaker of the Assembly each appoint a public member. On another PAC topic, prior legislation provided a mechanism to impose new CME regulations for license renewal. Renewal applications being sent out as of January 1, 2013 will require compliance with the new regulations as a condition for relicensing. For an explanation, see a companion article on page 19. 

NOVEMBER/DECEMBER 2012

Crayolas, Pipelines and Authentic Diversity by Michael J. De Rosa, MPH, Ph.D., PA-C, PA Program Relations Chair

et’s assume for a moment that we know what “diversity” in health care education means or could agree on a definition. According to the federal government a few billion “Asians” from China and India aren’t even Asian anymore. At least they don’t count as “diverse” for the purposes of diversity outcomes… this week. Federal guidelines on classification of race and ethnicity have changed no fewer than three times since 1977. Significant aspects of this change are, of course, positive. It was not until 2007, for example, that individuals were allowed to selfidentify their ethnicity or invited to list multiple races in describing their heritage. And still, diversity has been a moving target. For the purposes of our institutional track records and reporting on diversity to the government and funding agencies, if you’re from China, India, the Philippines, Japan or Thailand, apparently you’re just as white (or at least non-diverse) as the white kid from Madison, Wisconsin. And, while we’re at it, let’s also stipulate that we could agree on something simple such as rural vs. urban. The US Census Bureau (USCB) defines urban as a “continuously built up area” with a population of 50,000 or more inhabitants but they allow for areas as small as 2,500 to be considered urban if the density of that population is high enough (2,500?!). And rural? Well, of course, that’s everything else. Here’s a quiz: Identify the rural California area according to the census bureau: a. Murrieta b. Fresno c. Victorville d. Lompoc e. Arroyo Grande 10

CAPA NEWS

In fact, they are all considered urban by the USCB. So is Petaluma. But, and here’s a kicker, no other agency at any level is required to agree or to use the same standards. Why do we care? We care because health care is changing. We care because the profession is changing. We care because one of the little discussed benefits of the Affordable Care Act and part of its brilliance is that it has shined a white hot light on the issues of diversity and culture in health care – or the lack thereof. But in this regard, most of us are behind the curve. The government has been willing to put significant resources into this issue, with typically little in the way of guidance or support. It is imperative that we expand the workforce to meet growing demand under ACA. But the additional requirements to improve diversity and cultural competence have been added and force us to expand the workforce by opening opportunities to physician assistant positions and training programs to a far wider segment of the population. This drive to diversify and expand the workforce through expanding training opportunities and recruiting and retaining a more diverse pool of candidates while expanding our practice opportunities is important and inherently challenging. Currently, we are grappling with any number of issues including but not limited to: legislative efforts to expand PA employment opportunities, clinical training sites for our current candidates, as well as larger class sizes, the rising cost of tuition and debt load driving graduates ever more often into specialty practice and processes by which to identify and retain more diverse students.

Initially, we will do what we can: work to build pipelines that serve as feeders for the PA profession and extend into underserved and underrepresented environments while PA education takes a detailed look at the admissions process in the hope to eliminate bias in recruiting. We will compete for the pool of “qualified” candidates from underrepresented groups and we will admit them to our programs. But if the admissions process is inherently biased toward those of privilege (regardless of their skin color) then aren’t “qualified candidates” by definition privileged? Without real reform to the admissions process and educational opportunity, our initial efforts will be tantamount to treating our classrooms like a box of Crayola crayons – open the box and select the colors you want. It’s a start. And government “outcomes” hawks will be appeased. Money will flow. But it may not result in authentic diversity. Again, in this regard, PAs will lead. The notion of holistic application review with an eye toward the elimination of bias is being discussed with energy and commitment throughout medical training and especially within PA education at the national and local program levels. Through all of this work the state of care in the State will be improved, more patients will receive needed care, the physician assistant will play a central role in this development and, ultimately, we will develop a more diverse and more integrated workforce. The California Academy of Physician Assistants has been extraordinarily successful over the last two years at making the Continued on page 11

PA Means Political Action, Too! by Sonny Cline, PA-C, MA, M.Div., Political Action Committee Chair

hysician Assistants - it’s truly amazing all that you do for the State of California! Most people don’t know how many lives you save in one week, how many children’s lacerations you suture, how many battered and frightened women you comfort, how many diabetics you convince to take their condition seriously and ultimately make real changes in people’s lives. You do amazing work every day, every week. Thank you, as a citizen of this state, thank you. Because of the difference you make every day, we need to stay vigilant to make sure those in the Capitol know about you. We want them to know what you are contributing to this state. We want them to know that you make a difference, not only in the bottom line, but in the quality of life here in the State of California. Health care is better here because of you and that is CAPA’s message to state legislators. Our focus in the CAPA Political Action Committee (CAPA PAC); is to educate legislators on just how important you are to the health care system in California. Every year, important legislation regarding health care comes across the desk of every legislator. We cannot afford to have a voting member of our legislature making decisions without knowing

the answer to the question: “What is a PA?” We want them all to be able to answer that question definitively and have no questions about our capabilities and what we bring to the table. Your CAPA PAC contributions put us in the position to be heard and taken seriously. Many of you already know this and have generously contributed to the CAPA PAC. Along those lines, I would like to take this time to say thank you to the many people who contributed to the CAPA PAC, in a variety of ways, recently at our annual statewide conference held in Palm Springs. We had phenomenal help from the Student Ambassadors. There were so many who helped and did great work with enthusiasm. I want to thank all the Student Ambassadors who gave their hours of time to sell fans, run the spin wheel and greet all who came to the CAPA PAC table. You did a great job! We hope you will continue to remain involved with the CAPA PAC as you move into PA practice. I would also like to thank the CAPA Board of Directors for your support through volunteering at the tables, donations and general encouragement for what we are trying to accomplish with the CAPA PAC. I personally want to extend thanks to Gaye and the staff at the

CAPA office for all their support and answering the multitude of questions that I have had since taking the position of CAPA PAC Chair on July 1st. Lastly, I would like to thank Cherri Penne-Myers. Cherri has held the position of CAPA PAC Chair for many years. She has done a wonderful job and deserves all of our thanks. I would not have been able to function without the help of Cherri at the CAPA Conference in Palm Springs. She truly took me under her wing and showed me the ropes of fund-raising and exposure for the CAPA PAC. She was very gracious in her willingness to help out this year and is an example of outstanding service to our profession. Thank you, Cherri, for all you have done and continue to do for CAPA and the CAPA PAC. We have made great gains in carving out a niche for PAs in the California health care system, but there is much more to be done. I hope you will continue to support your CAPA PAC in the days ahead and educate your colleagues regarding the CAPA PAC. I look forward to seeing everyone in Napa for our winter conference. It is sure to be a great time. Stop by the CAPA PAC table and let me know who you are and let’s move forward together. 

Crayolas, Pipelines and Authentic Diversity Continued from page 10

physician assistant a central part of this conversation. Recommendations going to the Governor’s office at the end of this year will include PAs as a priority pathway for workforce development among several other

recommendations that would support physician assistant training and practice expansion in real and tangible ways. Funding and legislative efforts are being targeted to the support of the physician assistant as

a central player in the expansion of health care and our health workforce. It remains a very interesting time to be PA! 

NOVEMBER/DECEMBER 2012

CAPA’s 36th Annual Conference by Eric Glassman, MHS, PA-C, CME Committee Chair

CAPA President, Adam Marks, PA-C presents Eric Glassman, PA-C with a “thank you” gift basket for his exceptional job as CME Chair.

APA’s 36th Annual Conference in Palm Springs from October 4th through the 7th has come and gone. We had almost 1,000 people in attendance this year. CAPA’s second home truly is the Renaissance Hotel and Palm Springs Convention Center every Fall. For many of you, this was not your first trip out to the desert, but for some of you it was your first experience. The CAPA Conference culture is felt at this conference and there is always a positive vibe and great energy. The conference theme this year was the Fabric of the PA Profession. We had hundreds of PAs participate in this inspired concept. We made short videos (10-15 seconds) that introduced ourselves, our specialty and our practice location. The completed videos were linked together into video collages and viewed as we entered the ballroom for the Conference meals. It was such a great way to get to know our fellow colleagues. It also showed the unlimited variety, diversity and uniqueness of PA practice. We have posted these videos on CAPA’s website for all to see and I hope you enjoy them. CAPA also offered a service this year at the Annual Conference that our members both loved and appreciated. We helped with the registration process for California’s Prescription Drug Monitoring (CURES) program. We removed the biggest

CAPA NEWS

barrier to the CURES registration process and provided an onsite notary at no charge to all attendees. For those who use CURES in your daily practice, you know this is an invaluable tool. I need to thank all those that made this conference possible. We have a great staff at the CAPA office who work hard year-round planning this conference led by our CAPA COO, Gaye Breyman, CAE, as well as Denise Werner, Kim Dickerson, Coryn Kulesza and Emily McCoy. Our CME Committee team did a great job on site to make sure that the Conference ran like a well oiled machine. Thank you to Roy Guizado, PA-C and the hard work he does every year with the Student Ambassador Program and great big thank you to those students who volunteered this year. A special thank you goes out to our Conference Planning Committee Chair, Tim Wood, PA-C and his extraordinary committee members who worked to create a well-balanced program with top notch speakers. I can’t remember a year with such interesting topics, as well as an all-star lineup of speakers. The quality of CME offered this year was unparalleled. In addition to the 21 CME credits available during this conference, many of you came for the extracurricular activities. To start with, let’s talk about the PArty/Dance and American PA Idol competition. The Palm Springs Convention Center foyer is a great place for this PArty and the DJ knew how to keep the fun going with great music. The talent of this year’s PA Idol contestants was, once again, amazing. Thank you to those that participated. You all did a great job! This year’s winner comes to us from Western University’s first year PA class. Congratulations to Jamie McCoy, PA-S for rocking the house,

we hope that you will be back next year to defend your title. The Student Challenge Bowl was once again a huge hit. The pool deck on Saturday afternoon was standing room only. We had seven schools participate for a chance to win the cherished “Cup” including first time participant, Loma Linda University. This year’s winner was USC with a great performance from start to finish. Lastly, we honored long time and indispensable CAPA leader, Bob Miller, PA-C with CAPA’s highest honor, the Pride of the Profession Award. To date, only three other recipients have been honored with this award, former PA, Congresswoman Karen Bass; current Physician Assistant Committee Chair and past CAPA President, Robert Sachs, PA-C and CAPA COO, Gaye Breyman, CAE. Bob joins this elite company and is quite deserving. Bob has served as CAPA President in 2003 and is currently Treasurer and Professional Practice Committee Chair. He has served CAPA and California PAs for over 17 years. For those of you in attendance, you know this was a special moment we shared as we honored one amazing California PA. As you can see from the pictures in this issue, this is the conference to attend and it always seems to get better, year after year. Whether it was your annual trip to the desert to join us or your first time with us, we hope you had a wonderful experience and hope you will be back in 2013. We hope that we will see you in Napa on February 23rd or next year in Palm Springs. 

The Fabric of the PA Profession Videos At the CAPA Conference we always celebrate all that makes PAs special. We are all unique and bring our interests, training, experience, style and diversity to the table. CAPA members practice in each and every specialty and in all practice settings. What we know is there is no typical PA. At this year’s CAPA Conference (October 4-7), we shone a light (a video camera, really) on over 250 PAs who visited the Fabric of the PA Profession Video Booth. Each video was sewn together to create a peek into the wide variety of health care services PAs provide. You will be inspired and surprised by the rich diversity of PAs – by the Fabric of the PA Profession. Over 40 years ago, the creators of what was then called the new health professional intended the American PA to be flexible and contributory in all aspects www.yo of medicine. For them, a dynamic, flexible clinician who differed from a utube.co m/ CAPACon doctor was a concept to be promoted. The PA of the new century seems nection to have lived up to that measure. Dr. Stead, founder of the profession would be very proud of the richness and beauty of the Fabric of the PA Profession in 2012. At the CAPA Conference we celebrated PA Day, October 6, which is Dr. Stead’s birthday and also the date the first class of PAs graduated in 1967. Our thanks to all of the PAs who visited the Fabric of the PA Profession Video Booth and who provide care in all specialties and work settings. We will be shooting more Fabric of the PA Profession videos at the CAPA at Napa Conference (February 23) and the Controlled Substances Education Course in Napa (February 24). If you are in Napa for one or both of these days, we hope you will film your brief video introduction.

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NOVEMBER/DECEMBER 2012

2012 Student Challenge Bowl by Anthony Gauthier, PA-C, ATC, Director-At-Large

magine relaxing poolside in Palm Springs with a cold drink in your hand, great music filling the air and to top it off…surrounded by friends. If you attended this year’s CAPA Conference, this was reality. Hundreds gathered poolside Saturday at the Renaissance Hotel, as the sun sank behind the mountainside producing a sunset that would inspire Palm Springs’ local artists, for this year’s Student Challenge Bowl (SCB). The “PArty” kicked off as the band, Taxi Wisdom, with fellow PA Greg Mennie on drums, rocked the stage. They got the crowd dancing and singing as they played familiar past and present hits. Their music transformed the pool at the Renaissance Hotel into Palm Springs’ top music venue.

San Joaquin Valley College won the title last year, but this year the competition was tough and it was anyone’s game. The teams had feverishly studied and were ready. The crowd was full of so much energy it was as if the entire hotel was powered by them. No competition can commence without an emcee, judges and ancillary staff. This year, the event was privileged to have a great staff and Dr. Bradford Stiles returned to be the emcee. After doing such a great job for the past couple of years, it was an honor to have him back. The score keeper was CAPA Vice President, Jeremy Adler and the time keeper was CAPA CME Committee member, Chris Clark.

With the crowd growing and the excitement building it was time for the main event: CAPA’s 2012 Student Challenge Bowl. This event is regarded by many as one of the highlights of the Conference weekend. Students and PA Program Alumni enjoy the friendly competition between PA Programs, the relaxed atmosphere of being poolside and the provided refreshments. PA Programs throughout California participate each year, keeping the tradition alive. Prizes are awarded to the top three teams, with the first place Program receiving the coveted Student Challenge Bowl trophy and bragging rights of being the top PA Program for 2012. This year, seven programs signed up to participate and give it their all to win and be crowned the 2012 Champion. 14

CAPA NEWS

2012 Student Challenge Bowl Champion - USC!

This year’s judges read like a Who’s Who of the PA Profession. Our first judge was a former CAPA President, he worked in primary care for Kaiser Permanente in San Diego for 27 years and is an officer in the Navy Reserve, where he is in charge of a medical unit in Coronado, California: Mr. John Western, PA-C. The second judge was also a past CAPA President, a past AAPA President, currently practicing in Bakersfield, California, in burn, plastic, and reconstructive surgery: Mr. Steve Hanson, PA-C. Our third and final judge was past CAPA President and current AAPA President and practices orthopedics at UT Southwestern

Medical Center in Dallas Texas: Mr. James Delaney, PA-C. The SCB began with a close first round competition as USC, Touro, and Stanford battled it out. USC won moving on to the finals. The second round paired first-time SCB participants, Loma Linda against Riverside Community College. Loma Linda proved too much for RCC and moved on to the finals. In the third round, Western did their best but could not get past the defending champions, San Joaquin Valley College (SJVC). The three winning teams from the previous rounds gathered for the final round. It was anyone’s match. As defending champs, SJVC had to face a determined USC and first- time participants Loma Linda. The round was well played and came down to the final question as USC went on to become this year’s champion. For their efforts, the team members of the top three teams each received an iTunes gift card. Champions, USC, also received $250 dollars toward their student society, the SCB trophy and bragging rights for the year. The PArty continued, Taxi Wisdom closed out the night playing great music as fans, program alumni and teams celebrated the completion of this year’s Student Challenge Bowl. Congratulations to all of the teams that participated! I hope that next year you will be back to cheer your program on. 

Robert Theodore Miller, PA-C Honored with Pride of the Profession Award by Larry Rosen, PA-C, Director-At-Large

ith more than 500 physician assistants gathered for lunch at CAPA’s 36th Annual Conference in Palm Springs, the sounds of popcorn popping (Bob’s favorite food) kicked off the award ceremony honoring Bob Miller. Bob has been a dedicated CAPA leader for 17 years, serving as President, Government Affairs Committee Chair, Treasurer and Professional Practices Committee (PPC) Chair. As PPC Chair, Bob’s been our go-to-guy for all questions related to physician assistant practice in California. His grasp of the intricacies of the laws and regulations that govern our profession has been an invaluable resource for PAs and CAPA leaders. The job attracts an endless stream of emails and phone calls and nobody does it better.

of Clinical Pediatrics and Family Medicine at Children’s Hospital LA and USC Keck School of Medicine, he established an exemplary career of teaching and healing. At one time or another, most of us attending the conference have been taught hematology by Bob. He has lectured all over the world on coagulation defects and has been honored time and time again for his impressive work in hemophilia’s. But, in Palm Springs, Bob was honored for his long time commitment to CAPA and its members. Over the years he has engaged with CAPA and physician leaders, debating, negotiating, always dedicated to protecting the physician assistant’s right to practice medicine to the full extent of their license.

A tribute to Bob’s command of the issues is his thoughtful and concise PROFESSIONAL PRACTICES VIDEO SERIES available on the CAPA website (www.capanet. org.) It is a primer for all of us who wish to understand the history and complexities of PA practice in our state.

Spreading the love at the award presentation were ten past CAPA Presidents:

Bob began his career as an army medic. He trained at Los Angeles County/USC Medical Center and in 1975, 37 years ago, he passed his boards; license number 10605. His first position was at the USC Pediatric Pavilion emergency room where a love for caring for children with bleeding disorders took hold. In 1982, he was recruited, because he was that good, to specialize in hematology-oncology at Children’s Hospital Los Angeles.

John Western, PA-C - 1996

And for 30 impressive years, he did just that; rising to Assistant Professor

Each, in their own words, lauded Bob for the security he provided

Robert Sachs, PA-C - 1988

during their term in office, insuring a steady, competent voice on the other end of the phone when support was needed. Bob retired from medical practice this year, on August 2nd, allowing him time to pursue his love for boating and travel and time with his charming wife, Connie. But he continues to teach and, lucky for us, remains on as CAPA’s Treasurer and Professional Practice Committee Chair. We wish Bob well in the years ahead and celebrate his commitment to CAPA and its members.

Les Howard, PA - 1993 Julie Thierault, PA-C - 1994 Stephen Hanson, MPA, PA-C - 1995 James Delaney, PA-C (current AAPA President) - 2001 & 2004 Jennifer Faggionato, PA-C - 2006 Miguel Medina, PA-C - 2008 & 2009 Eric Glassman, MHS, PA-C - 2010 & 2011 Adam Marks, MPA, PA-C (current CAPA President) - 2012 and CAPA COO, Gaye Breyman, CAE

Smooth sailing, Mr. Miller. 

NOVEMBER/DECEMBER 2012

CAPA’S 36TH ANNUAL C O N F E R E N C E

Jamie McCoy, PA-S 2012 PA Idol

CAPA NEWS

THE FABRIC OF THE PA PROFESSION

Competent, Versatile and the Texture of Compassion Thank You - Taxi Wisdom

NOVEMBER/DECEMBER 2012

Physician Assistants for Literacy (PALs) by Joy Dugan, MPH, PA-C, Secretary

Joy Dugan, PA-C reading to children in Palm Springs during the 2012 CAPA Conference

or the past five years, on the first day of the CAPA Conference in Palm Springs, CAPA volunteers visit Vista Del Monte Elementary School to donate books and promote literacy. Typically, we visit a classroom, read to the students from donated new books and promote the physician assistant profession. This year, Kimberly Warburton, MPH, PA-C and I visited the after-school program. Over the course of an hour, we took turns reading to approximately ninety children from the book entitled You Are Weird by Diane Swanson. The children were eager to read aloud various passages from the book about their favorite topics including: “why we sweat” and “bursting appendix.” The students also took turns using our stethoscopes to listen to heart and bowel sounds. One of the favorite parts of the program this year was learning how

to perform a neurological exam. They were fascinated by the pupillary reaction to light and especially enjoyed testing Cranial Nerve VII (Facial Nerve)! Laughter was uncontrollable when they were told to furrow their eyebrows and puff out their checks. Every year we stress increasing reading and decreasing overall screentime of television and computers. The children were shocked by the American Academy of Pediatrics recommendation for a maximum of one to two hours daily of total screen time unrelated to academics. Many of the children reported upwards of five hours of television nightly. From a public health perspective, promoting literacy is crucial to improving overall health. Those with lower literacy skills are thought to have greater difficulty navigating the health care system and are thus at risk of experiencing poorer health outcomes1. Low literacy is associated with low health knowledge, increased incidence of chronic illness and decreased utilization of preventative health services2. For example, rates of cervical and breast cancer screenings were significantly less among women with inadequate literacy3. Further,

patients with inadequate literacy had decreased influenza or pneumococcal immunizations compared to patients with adequate literacy. I encourage you all to participate some way in “PALs.” You could start by just having a book drive at your office. If you would like to participate in our yearly PALs project in Palm Springs, let me know! For more information on CAPA’s “PALs” Project, feel free to email me at joy. dugan@tu.edu.  References 1.U.S. Department of Health and Human Services Agency for Healthcare Research and Quality Evidence (2004). Literacy and Health Outcomes. Accessed: http://archive. ahrq.gov/clinic/epcsums/litsum.pdf 2.Gazmararian JA, Baker DW, Williams MV, et al. (1999). Health literacy among Medicare enrollees in a managed care organization. JAMA; 281(6):545-51. 3.Scott TL, Gazmararian JA, Williams MV, et al. (2002). Health Literacy and Preventative Health Care Use Among Medicare Enrollees in Managed Care Organization. Med Care; 40(5): 395-404.

2012 Update: Cervical Cancer Screening Guidelines Continued from page 6

References: 1. American Congress of Obstetricians and Gynecologists. (2012, March 14). Retrieved from http://www.acog.org/ About_ACOG/Announcements/ New_Cervical_Cancer_Screening_ Recommendations 18

CAPA NEWS

2. U.S. preventive services task force. (2012, March). Retrieved from http://www. uspreventiveservicestaskforce.org/ uspstf/uspscerv.htm 3. (2012). American cancer society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical

Pathology screening guidelines for the prevention and early detection of cervical cancer. Retrieved from http://onlinelibrary.wiley.com/ doi/10.3322/caac.21139/pdf 4. Cancer among women. (2011, February 10). Retrieved from http://www.cdc. gov/cancer/dcpc/data/women.htm

New CME Requirements for Renewing Your California PA License! by Bob Miller, PA-C, Professional Practice Committee Chair

ou are probably aware by now that there is a new 50 hours of Category I Continuing Medical Education (CME) requirement when renewing your California PA license. If you have your NCCPA Certification, your “C,” at the time of license renewal—you’re covered. You do not need an additional 50 hours beyond your NCCPA requirement.

At last count, out of the nearly 8,000 licensed PAs in California, there were approximately 15% who did not maintain their Certification, and as such, had no mandate to seek continuing medical education. Remember that “If you have your NCCPA to initially obtain a California PA Certification, your “C,” license, you need to graduate from an at the time of license approved program renewal—you’re covered. and have NCCPA Certification. You do not need an However you are not additional 50 hours beyond required to maintain your “C” for practice your NCCPA requirement.” or for license renewal in California. Most do maintain their “C” for a variety of reasons – one is the growing trend for employers and other health related organizations to require the Certification as criteria for employment or malpractice insurance for example. The “C” also allows the flexibility to travel to practice in other states where it may be required for licensure. The CA Business and Professions Code (B&P Code) now includes Section 3524.5 which states that, “The committee may require a licensee to complete continuing education as a condition of license renewal ...” This section establishes a limitation in that, “The committee shall not require

MANDATORY CME

more than 50 hours of continuing education every 2 years.” It also allows the Committee to accept current Certification by the NCCPA as evidence of compliance with these requirements. I was pleased to have been invited to sit on the task force to develop the new regulatory language which is now found in Title 16 of the California Code of Regulations (CCR), Sections 1399.615 to 1399.618. These sections cover the continuing medical education to be required, the Category I accrediting organizations, the mechanism for potential audit and possible sanctions for non-compliance. There is also the possibility of a waiver of this requirement for a renewal cycle for reasons of health, military service or undue hardship – all determined at the discretion of the Committee. You can find this regulation on the PAC website* along with a section for FAQs. Completion of the 50 hours of CME must be approved Category I (preapproved) medical education. The CME must have been obtained from providers that are designated Category I preapproved by one of the following sponsors: •

American Academy of Physician Assistants (AAPA).

•

American Medical Association (AMA).

•

American Osteopathic Association Council on Continuing Medical Education (AOACCME).

•

American Academy of Family Physicians (AAFP).

•

Accreditation Council for Continuing Medical Education (ACCME).

•

A state medical society recognized by the ACCME.

The following bullet points highlight this new CME requirement: •

At the time of license renewal, if you have current NCCPA Certification, you DO NOT need the additional 50 hours. Having current NCCPA Certification at the time of renewal is considered to be in compliance with the new regulations.

•

50 hours of Category I CME will be required every two years for California PA license renewal if the PA is not currently Certified by NCCPA.

•

The 50 hours of qualified CME must be completed during the two-year period immediately preceding the expiration date of the license.

•

PA license renewal on or after January 1, 2013 will require checking a box on the renewal application to personally

Continued on page 26

NOVEMBER/DECEMBER 2012

Registe r Today

s 6 Hour Cat. I CME

Controlled Substances Education Course A Course Which Upon Successful Completion Will Allow You To Write For Controlled Substances Without Patient Specific Approval* Sunday, February 24, 2013 Napa Valley Marriott 3425 Solano Ave Napa, CA 94558 (707) 253-8600

Saturday, April 20, 2013 Scripps Green Hospital Timken Amphitheater 10666 N Torrey Pines Rd La Jolla, CA 92037

*California Code of Regulations Sections: 1399.541(h), 1399.610 and 1399.612. A PA may administer, provide, or issue a drug order for Schedule II through V controlled substances without patient specific approval if the PA completes specified educational requirements and if his/ her Supervising Physician delegates the authority to them. Courses will be canceled if minimum number of registrants is not met.

Comments From Previous Courses Palm Springs—September 21, 2011 “Enjoyable yet informative presentations from Dr. Lowe and Jeremy Adler, PA-C. Both instructors made the topics discussed interesting and applicable. Thank you!”

Oakland – August 25, 2012 Very good speakers. Entertaining & informative. Thank you! Course was overall fantastic and very applicable to clinical practice. Inspiring and practical – Perfect!

Palm Springs – October 3, 2012

SAVE THE DATE—Feb. 24, 2013 “Mental Health Across the Life Span” Plan to attend a free one-day mental health conference, hosted by Touro University California, the day after the CAPA at Napa conference. Topics will include: adult ADHD, psychopharmacology, and issues specific to returning veterans. When: Sunday 2/24/13, 9am-4pm Where: Napa Marriott Cost: FREE; meals provided

Make the most of your trip to Napa!

Great course, very informative and practical. Thanks – I wish I had this kind of course years ago! Very informative. Thanks for mixing in “real life” stories and a little humor!

CAPA NEWS

For more information or to RSVP, contact Julie Charles at 707-638-5875 or email: julie.charles@tu.edu

Cont Subs rolled ta Co nces on Suurse nday

One-Day Conference in Napa at the Napa Valley 6 Hours of Cat. I CME

Saturday, February 23, 2013 8:45 a.m. - 4:15 p.m.

CAPA at Napa

Sponsored by the

Join us in Napa. We have developed an excellent educational program set in the beautiful, lush green Napa Valley and offer it to you at a very reasonable price. CAPA is coming to Napa and you won’t want to miss it!

Program

California Academy of Physician Assistants Application has been made to the American Academy of Physician Assistants (AAPA) for 6 hours of Category I CME credit. Approval is pending.

Registration Form

Registration

Name________________________________________________________

8:00 a.m. – 8:45 a.m.

Continental Breakfast and Exhibits

 PA-C  PA  PA-S  NP  MD/DO  Other___________________

8:45 a.m. – 9:40 a.m.

PA License #___________________________________________________

EKG Treasure Hunt - Using a Chief Complaint Based Approach to Reading 12 Leads Jennifer Carlquist, PA-C

9:40 a.m. – 10:35 a.m.

Legal Issues Update Robert Miller, PA-C and Michael Scarano Jr.

Phone (____)___________________ Fax (____)_______________________

10:35 a.m. – 11:20 a.m.

Break and Exhibits

11:20 a.m. – 12:10 p.m.

5 Common Pediatric Sports Injuries James Ting, MD, FAAFP

12:10 p.m. – 1:00 p.m.

A Primer for Working up Anemia Speaker TBD

1:05 p.m. – 1:15 p.m.

Legislative and Public Policy Update Teresa Anderson, MPH

8:00 a.m. – 8:45 a.m.

1:15 p.m. – 2:15 p.m. Lunch (not eligible for CME) Diabetes Update Speaker TBA 2:20 p.m. – 3:10 p.m.

Pain Update Jeremy Adler, MS, PA-C

3:10 p.m. – 4:00 p.m. TBD Speaker TBD 4:00 p.m. – 4:15 p.m.

Prize Drawing and Closing

6 Hours Category I - CME Credit Applied For Application has been made to the American Academy of Physician Assistants (AAPA) for 6 hours of Category I CME credit. Approval is pending. Courses will be canceled if minimum number of registrants is not met. The planners and sponsors of this function claim no liability for the safety of any attendee while in transit to or from this event. The planners and sponsors reserve the right to change speakers and/or cancel the event due to unforeseen circumstances without penalty. The total amount of any liability of the planners and sponsors will be limited to a refund of the registration fees.

Address____________________________City________________________ State________________________________ Zip Code_________________

Work Address__________________________________________________ City_________________________________________________________ State________________________________ Zip Code_________________ Phone (____)___________________ Fax (____)_______________________  CAPA Member - $150  Non-Member - $240  PA Student - $50  Napa Conference and CAPA Membership through 4/30/14 - $275  Late Registration Fee after January 25, 2013 - add $20  Bring a Guest to Lunch - $37 (must be over 18) Name(s)_________________________________________________  Vegetarian Meal Required or  Gluten-Fee Meal Required 

Total Amount $______________



Signature_____________________________CVV#______ Exp.__________  In accordance with the Americans with Disabilities Act, please check here if you have any special needs. You will be contacted by CAPA. Mail Registration Form and make checks payable to:

CAPA

California Academy of Physician Assistants 2318 S. Fairview St. • Santa Ana, CA 92704Phone: (714) 427-0321 • Fax: (714) 427-0324

or Register online at: http://www.capanet.org

NOVEMBER/DECEMBER 2012

The Poverty of Health Care by Michael Estrada, PA-C, MS, DHSc, Committee on Diversity Chair

ebster’s definition of poverty is directly related to someone who lacks a usual or socially acceptable amount of material possessions. But poverty should not just be defined by the amount of material possessions one must have, but also by the lack of those elements necessary to maintain human identity and dignity. Lack of acceptance, inclusion and access can also be included in the definition of poverty. Health care, the hot topic of our day, seemingly falls short in many ways and fits the very definition of poverty. The lack of access to care and the inclusion of populations is an area of concern for diverse people and for those who provide health care to them. It is impossible for health care professionals to ignore the special problems and needs of patients from these communities (Clark, 1983). Language may be the primary barrier but other issues such as cultural beliefs and health care problems are prominent within these communities. Issues in health care in these communities include infectious diseases such as tuberculosis, syphilis and HIV. And not to mention, the stigma that many of these diseases carry, sometimes resulting in non-inclusive care. You don’t have to be a person of color to carry the stigma of disease. But, historically, people of color have a disproportionate rate of health disparity. In many instances, immigrant populations may have limited access or no access to health and dental care. Many rely upon relatives still living in their respective countries to send them medications or ask advice of health care providers about a particular condition or ailment. The reality is that increasing numbers of minority group patients are likely to find their way into our offices, hospitals and clinics. 22

CAPA NEWS

Cultural diversity and sensitivity is a controversial topic. In hospitals and academic institutions many professionals are required to take cultural sensitivity courses. These courses outline any potential misunderstandings that one may encounter while practicing in a culturally diverse population. If health care professionals are serious about their desire to provide the best care for all patients without regard to their race, gender or ethnicity, it is important that they educate themselves and become culturally competent (Galanti, 2001). Cultural awareness should be an important part of higher education, especially in those institutions training future health care professionals. Case studies are often utilized to teach PA, nursing and medical students. They exemplify interview techniques and physical assessments on standardized patients. The Department of Medicine at UCLA uses this technique and mixes in cultural issues within some of the cases. Many nursing programs require that their students involve themselves in cross cultural activities. Some of these activities are often lead by culturally diverse students. Cal State Dominguez Hills University requires their nursing students to fulfill a four unit course on human diversity. The Accreditation Review Commission on Education for the Physician Assistant, the accrediting agency that protects the interests of the public and the physician assistant profession, requires PA schools to provide training in cultural competence. Much of the training often expands beyond ethnicity but also addresses gender and religious customs. Many health professionals think that if they treat each patient with respect they will avoid most cultural problems (Galanti, 2000). The fear of

being misunderstood or seeming to be uncaring can sometimes influence how they act around ethnically diverse patients. The inability to communicate in one’s own native language can sometimes create a feeling of mistrust. These issues can create confusion on behalf of both patient and health care provider. Cultural differences can also cause conflict among health care personnel. Since the immigrant population is not just limited to the laborer, many immigrants are professionals and become licensed in the United States to practice in their respective fields. Many foreign graduate health care professionals are not familiar with the U.S. health care model and believe that they can continue practicing with customs that aren’t necessarily recognized as correct in the U.S. Some of these customs include gender role responsibilities and professional hierarchy. For example, nurses in the United States are taught to be patient advocates. They are taught to be a counter balance to the physician and bring any potential errors to the attention of the physician. But in other countries and cultures, nurses are subordinate and are to never question the orders administered by a physician or a higher authority. This may cause conflict and possibly create a hostile and potentially dangerous environment for both staff and patients. It may be helpful if hospitals offered training to their foreign born staff on the expectations of American hospitals and gender relationships and the roles they play. Immigrants come to the United States to seek freedom from politics, to build a better life and prosper economically. Cultural diversity is an important part of America. It brings many unique beliefs and practices that are sometimes not understood. In health care and

healing these beliefs may sometimes contradict what we perceive as normal. Recognizing that we have differences in ethnicity, cultural customs and views on health will allow us to better serve ourselves and provide treatment for culturally diverse populations with greater care and understanding. In our growth as a global community, the views that we share with each other and those we teach can influence a change that nurtures unity and respect for those differences that make us unique. In the year to come, the Committee on Diversity is working on resources that will provide information about cultural issues, practice guidelines and link

outs from the CAPA website that not only addresses culturally competent health care but, most importantly, provides the support necessary to create access to care. The role of the PA is expanding and creating access to care should be of paramount importance for our profession. Our numbers are increasing and so is our presence in communities that are in need of inclusive and culturally competent health care. We are hopeful that these resources that will be provided to you will have an impact on how we provide care and improve communication among all populations. Feel free to contact me anytime on issues relative to cultural diversity. I am here to serve you as a CAPA representative. 

References Barker, J.C. (1992). Cross-cultural Medicine A Decade Later: Cultural Diversity - Changing the Context of Medical Practice. Western Journal of Medicine, Sep; 157:248-254. Clark, M. (1983). Cultural Context of Medical Practice. Western Journal of Medicine. Dec; 139:806-810 Galanti, G.A. (2000). An Introduction to Cultural Differences. Western Journal of Medicine. May; 172:335-336. Galanti, G.A. (2001). The Challenge of Serving and Working with Diverse Populations In American Hospitals. The Diversity Factor. Spring; 9(3):21-26 Maduro, R. (1983). Curanderismo and Latino Views of Disease and Curing. Western Journal of Medicine. Dec; 139(9):868-874.

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CAPA’s 36th Annual Conference by Eric Glassman, MHS, PA-C, CME Committee Chair

You’re “on-call” 24/7. Make sure your malpractice coverage is too.

Individual professional liability coverage at competitive rates.

Physician Assistants Professional Liability Insurance 888.273.4686 | www.hpso.com/oncall This program is underwritten by American Casualty Company of Reading, Pennsylvania, a CNA company, and is offered through the Healthcare Providers Service Organization Purchasing Group. Coverages, rates and limits may differ or may not be available in all states. All products and services are subject to change without notice. This material is for illustrative purposes only and is not a contract. It is intended to provide a general overview of the products and services offered. Only the policy can provide the actual terms, coverages, amounts, conditions and exclusions. CNA is a registered trademark of CNA Financial Corporation. Copyright © 2012 CNA. All rights reserved. Healthcare Providers Service Organization is a registered trade name of Affinity Insurance Services, Inc.; (AR 244489); in CA, MN & OK, AIS Affinity Insurance Agency, Inc. (CA 0795465); in CA, Aon Affinity Insurance Services, Inc., (0G94493), Aon Direct Insurance Administrator and Berkely Insurance Agency and in NY and NH, AIS Affinity Insurance Agency. ©2012 Affinity Insurance Services, Inc. CAPA112

NOVEMBER/DECEMBER 2012

Specialty Care for the Uninsured: Building a Bridge to Better Access, Part 1 by Matthew Keane MSPA, PA-C, Director-at-Large

“T

he gap between the supply of specialty care for under and uninsured patients and demand has widened. A faltering economy has pushed more people into the ranks of the uninsured, while health care providers struggle to provide and coordinate specialty care to meet increasingly complex patient health care needs,” (CCHE, 2011). When I started as Program Director for Specialty Care for the Community Clinic Association of San Bernardino County in March of this year, nothing could have prepared me for how real the problem of access to specialty care for the uninsured really was.

starting point to ground you is elusive. Of the 21 specialty care coalitions that were funded through implementation, four key strategies were identified to help improve access. The four strategies are:

In January 2012, the Community Clinic Association of San Bernardino County began its first of a five year grant from Kaiser Permanente Community Benefits to research and improve access and utilization of specialty care for the uninsured and the underinsured. Kaiser Permanente along with the California Healthcare Foundation funded 28 coalitions from across the state to work on the issue of specialty care for the under- and uninsured. 21 of those coalitions eventually became fully funded to implement their specialty care initiatives. This is the first in a series of articles to look at the strategies that can be used to improve access to specialty care. The foundation for this series of articles comes from “Specialty Care Initiative Evaluation Report: Executive Summary” (CCHE, 2011).

3. Increasing primary care provider capacity and/or scope of practice – reducing demand for specialty care by increasing PCP capacity to manage basic specialty care needs.

Figuring out how to improve access to specialty care can seem extremely overwhelming and finding a good 24

CAPA NEWS

1. Embedding referral guidelines into the referral process – better managing demand for specialty care appointments by promoting appropriate referrals. 2. Building and expanding volunteer networks – increasing the number of specialists available to serve the safety net populations.

4. Integrating care coordination – improving referral coordination and patient navigation. The Embedding Guidelines into the Referral Process cluster (“Embedding Guidelines”) included strategies focused on implementing referral process protocols, clinical referral guidelines, and clinical decision support protocols and integrating these into new or existing referral systems (often electronic referral (eReferral) systems). The aim of these strategies was to better manage demand for existing appointments by ensuring more appropriate referrals. As Director of the San Bernardino County Specialty Care Coalition

this is one of the strategies that our coalition decided to undertake. In San Bernardino County there is one public or county facility which serves the uninsured and indigent population. This facility houses 23 different specialty care clinics that together combine for almost 250,000 specialty care visits every year. At the beginning of our coalition’s work, we worked very hard to create a good working relationship with the hospital. Through the coalition’s efforts and relationship building with the hospital, we are working closely with them to ensure that referral guidelines for each of their specialty clinics will be completed so that all of the community clinics have appropriate and adequate reference for appropriate referrals. Ensuring that community clinics are making appropriate referrals increases capacity to the specialty clinics because it ensures that patients are being referred based on established and published guidelines. These guidelines allow primary care providers, MDs, PAs and NPs to make sure that they are exhausting their treatment resources and only referring the most appropriate patients possible. Embedding referral guidelines is only one strategy that clinics can use to help improve access for the safety net population to specialty care providers. In the following issues of the CAPA News we will explore the other ways in which clinics can work with specialty care providers for the good of their patients. Stay tuned and until next time! 

ER Reflection By Lalia Gerges, PA-S her free-floating tibia found its way back in to place, relatively that is. I pulled with all my strength and I just focused on pulling.

esterday I experienced my first trauma, a tier one. She came in to the ED at 6:30 a.m. Her black curly hair was gnarled and soaked with blood, her cheeks were smeared red and a bag-valve-mask covered the rest of her face. Her abdomen was gravely distended, and also painted red. Her right humerus and pelvis were fractured. Her legs were hardly recognizable, with two largely open fractures of her tibias, and a contorted appearance of her knees. The room was chaotic yet structured, boisterous, yet eerily silent in my head. Everyone worked so quickly and efficiently, yet time moved slowly in the cliché way it’s expected to in such events. I found myself dissociating from the moment and from absorbing the whole picture. I never looked at her face again, I only looked at her legs, I just focused on her legs. I tried not to see anything else. I occasionally tried to peek through the crowd to see the intubation and chest tube placement, but it was too crowded and I was okay with that. The patient went in and out of pulselessness; doctors, nurses and paramedics scurried in and out of the room. The lead doctor noticed my lack of involvement and asked me to hold traction on her right leg. As I pulled on her ankle,

Threads of the patient’s story were coming through. The paramedics reported to the scribes and I tried to block the story out, but I could not. The team had done everything it could do, the patient had a pulse, was being transfused and sent to the ICU. On her way there she passed. The doctors brought me along to talk to the family. 20 family members encircled the room, and as the doctors gave the news, they fell to the floor and onto one another, broken and distraught. We left the room, with nothing left to do. Helpless. Confused. Emotionally exhausted. I felt like I was watching a movie, I knew I had just experienced something significant, memorable, dramatic, but it was not by choice. The lead doctor asked the nurses if there was anything that he could have done better and they asked the same of him, and it was over. Fifteen minutes later I was seeing patients again. No emotions were discussed, the patient was not discussed, and the event was not discussed. I was expected to act like what I had seen was normal, ordinary, and mundane. So that’s what I did, I acted like it was just another patient. I stayed busy and to my knowledge, unaffected. A student in the class ahead of mine, working in the same hospital, heard about the trauma and called to check up on me. He incessantly asked how I was doing throughout the day, and each time I told him I was fine. He approached me and encouraged my processing of the event, he told me his experiences in the past and the signs of post traumatic stress disorder he experienced from similar

events. I did not really understand his concern or the magnitude of what had occurred until later that night when I laid down and began to process what I experienced. I talked to my parents and started crying when they asked about my day. I cried to my boyfriend for an hour as he listened quietly. The director of my program even called to encourage me to process through the event. I was a mess of emotion and did not fully understand why or what I was most affected by. I just was. I kept revisiting her bloody contorted image, playing the suicide story back in my head, and seeing the family mourn. Was I prepared to experience this? No, but I am glad I did as a student. However, I do feel like my experience, and the experience of trauma, should have been addressed by the doctor I was working with. If that student had not counseled me with precaution and advice, I would have been embarrassed and bewildered by my emotional reaction. I realize the doctors have become compartmentalized in dealing with trauma and death, that they have seen so many similar cases they have forgotten their first tier one. Their first time seeing death is so distant, yet I pray that they can revisit their first time for the sake of their students. Every day on my way home I drive by the site she was hit, I see her family visit the site, and change the flowers. I will always remember my first tier one, but I will also remember the support I had to remember the event in a healthy way. 

NOVEMBER/DECEMBER 2012

Thank You, NAAPC

sincere (and belated) thank you to North Coast Association of Advanced Practice Clinicians (NAAPC) for their $2,000 donation to the CAPA PAC and $500 to the CAPA Scholarship Fund. The dissolving of the organization is in one sense, a success story. The commitment of the providers in the group should be commended. We sincerely appreciate their support over the years.

New CME Requirements for Renewing Your California PA License! Continued from page 19

certify compliance with the new CME regulations.

CAPA NEWS

•

The PAC may choose to audit a random sample to document CME compliance.

•

Evidence of Certification or CME must be retained for a minimum of four years.

•

Misrepresentation of compliance may “constitute unprofessional conduct” and can result in enforcement action and/or ineligibility for license renewal.

* Further information can be found on the Physician Assistant Committee (PAC) [soon to be the

Physician Assistant Board (PAB)] website at www.pac.ca.gov or you can call them at (916) 561-8780. Watch for possible changes in their web address as they transition to a Board. 

Students Students Students Students Students Students Coping Mechanisms During Your Didactic Education: A Current PA Student’s Perspective by Saloni A. Swarup, PA-S, Student Representative

ou have finally made it to PA school! Congratulations!!! You remember when you got your letter of acceptance? I bet you were jumping around the room and turning cartwheels just like I did! (Minus the cartwheels of course). And now you are in the deepest part of your first semester; up to your elbows in anatomy, physiology and PHARMACOLOGY! And now you find yourself thinking: WHAT ON EARTH DID I SIGN UP FOR?

If any of this sounds familiar, there is good news; YOU ARE GOING THROUGH ALL THE SIGNS AND SYMPTOMS OF BEING A PA-S! What you are feeling and thinking is perfectly normal. But the real question is, what can you do to help you get through this? Here are a few pointers that helped “Schedule in your school me out and I’m sure will help you too:

hours, meditation time,

Maintain a Healthy Diet I know you must be reading this and saying, “Are you and “YOU” time.” kidding me! I’m happy if I can find time to chew!” I can identify with that feeling, but the best thing that we can do as students is make healthier choices when we go grocery shopping. Take five minutes before you go to the grocery store to create a grocery list. Make educated decisions and pick healthier foods that will encourage better eating

exercise time, family time

habits. Once you have healthy foods in your fridge, you will automatically eat healthier. If you are not a grocery shopper and just find food as you go, make healthier choices when you buy food. This change will take some time to develop. But once you do, your body will thank you! Meditate for 10 Minutes Everyday Every morning, just after you wake up, find a quiet and serene part of your home. Just sit in that one spot and close your eyes. Take in deep breaths and just relax. Play some soft music while you do this if it helps. Since you have just woken up, this is the best time to do this. Once your day has started, you are so stressed and overwhelmed, achieving this state of relaxation would be hard. Exercise! I know this is the hardest one to do. But a healthy body and mind is so essential during this phase of your life. I do not think that this point can be emphasized enough. When I talk about exercise, I mean do something physical that you enjoy. If that means going to the gym and lifting weights, just do it. If it means going to a dance studio and dancing salsa for an hour, just do it. Do what makes you happy and helps you break into a sweat. Do this at least three times a week. Study Regularly in Short Bursts Many studies have shown that studying for long hours actually reduces the amount of information that you retain. Instead, studying in

short bursts helps you retain more information. The primary study was conducted by Hermann Ebbinghaus and he proposed the serial position effect. This study helped discover the “primacy” and “recency” effects. The primacy effect states that what you have studied in the earlier part of your studying is easier to recall. The recency effect states that the last thing that you studied is also easier to recall. As a result, the more breaks you take, the more primacy and recency opportunities you provide yourself with, the more you remember! Call Your Family Frequently PA school is difficult. It is going to be one of the hardest things that you will ever do in your life. You will need all the love and support that you can muster during this time. Please call your parents, grandparents, uncles, aunts, cousins or friends. Call anyone that you know will be there to help you and support you during this difficult time. At the same time, keep people who criticize you and demoralize you at bay. In the grand scheme of things, remember that educational experience is one of the best things that will ever happen to you! Take Out a Couple of Hours Every Week for “You” Time Never forget that you are the one who is the student. You are the one who is working endlessly and tirelessly to achieve your dreams. You have family and friends that are Continued on page 29

NOVEMBER/DECEMBER 2012

Students Students Students Students Students Students Study Habits for PA Students by Roy Guizado, MS, PA-C, Director-At-Large, Student Affairs Chair

he curriculum for physician assistant education is taught at a different level and intensity than undergraduate education. One coping mechanism that can help PA students in the transition from undergraduate to graduate education is the development of successful study habits. Study habits are learned and must be practiced to develop optimum results, and include organization, time management, selfdiscipline, and personal effort.

Schedule and Plan Organization is an essential skill when managing the increased studying required to pass your courses. Begin by creating a weekly planner which documents the important information from all your class syllabi, such as lecture times, tests and assignments for the entire semester. Use pencil, as schedules can change. Review your “Plan to spend about planner frequently and look for gaps in three hours of study time in which you can schedule extra study sessions. time for every hour of

class time.”

CAPA NEWS

Allow ample study time in your schedule. Plan to spend about three hours of study time for every hour of class time. This is just an average, some classes may require more or less time. In addition, schedule time prior to each class to review notes or reading, as well as a block of time immediately after each class (or as soon as possible) to study the information just presented.

Along with regular study times, schedule exam preparation time into your planner. Start reviewing material seven to fourteen days prior to the test. Weekend study is required to stay caught up in all classes and to do well in PA school. Be sure to build in weekly personal time. Try to stick to your schedule and remember that cram sessions are counterproductive. Study Smart Limit your study time for each course to no more than a two hour time span. At the end of two hours, switch to another course. This type of change promotes a more efficient study time. Study the more difficult material when your mind is sharp. Breaks play an important role in study. Take a five-minute break every hour. Physically get up and walk away. If possible, step outside and get some fresh air. Grab a healthy snack. But avoid the temptation of logging onto social networks, as five minutes can turn into an hour (or more). Find an area that is conducive to studying. A noisy environment provides distractions and makes for poor concentration. Avoid studying at home, as there are too many distractions there as well. Some suggestions for a study area include libraries, a study hall or a quiet coffee house. Know Your Learning Style If you are a visual learner, you may want to use colored pens or

highlighters while you study your material. A mental visualization of what the instructor is teaching can be formalized by drawing pictures, diagrams or mind maps. If you are an auditory learner, you may want to listen to sections of recorded lectures, read out loud, talk over ideas with your study group or listen to recorded textbooks. If you are a hands-on learner, write notes as you study, quiz yourself while walking or use the computer to help with learning. How to Study Reading is the key to studying. One excellent method of reading and studying is the SQ3R method: SQ3R – Survey, Question, Read, Recite (Recall), Review • Survey Preview the assigned chapter(s) of the textbook by reading the textbook chapter title, introduction, headings, summary paragraphs, pictures, tables, and diagrams. Read the first and last paragraphs in the chapter or section. Read the first and last sentence in the longer paragraphs. This scan provides background information, organization of topic structure, and prepares the brain for new information. •

Question Before formally reading the chapter/section, formulate questions in your mind regarding the headings surveyed in the previous step. For example, if you are reading a chapter on anemia and the first section is lab

Students Students Students Students Students Students section/chapter. The more you repeat the information the better your recall becomes. For an improved technique ask the questions and recite the answers aloud. If you do not recall the answer, read the section again. The more your repeat and recite the questions and answers, the better your recall of the information will become.

findings, formulate questions such as, “What are the lab findings for macrocytic, microcytic, and hemolytic anemias?” •

•

Read Read the sections/chapters with the purpose of finding the answers to the questions previously proposed. Look up words you do not know. Write notes in the margin, make diagrams, draw arrows or symbols, and mark up the book to increase your reading retention. Time permitting; you may want to outline the reading as you go. Highlighting the book is a technique used to identify the important material, but it is not effective for study. A superior technique is being able to answer questions you made about that section after reading. Recite/Recall Recall the questions and answers that you have made for each

•

Review Review occurs after the material has been read. Check your recall by reciting the main points from the reading. Get into the practice of reviewing material before and after each class. Again, the more repetition you perform, the better your recall will be.

When preparing for an examination, it is important to review the information in more depth. Remember the review cannot be performed adequately

until you have previously scanned, questioned, read and recited. The SQ3R study system can be adapted to the notes taken during lectures as well. The SQ3R system is utilized for all types of study including your pre and post class study sessions, as well as, your review sessions. Finally your weekly planner should have pre, post and review sessions for every class. The planner should visually indicate the two to three study hours needed for every lecture hour of class. Just as people are individuals, study habits can be adjusted to suit the individual learning style. These study habits should assist anyone studying for a class, quiz, exam, the PANCE or the PANRE. The skills do not come naturally and they must be practiced to be effective. 

Coping Mechanisms During Your Didactic Education: A Current PA Student’s Perspective Continued from page 27

always there to support you and take care of you. But remember, you need to take care of you too. Take at least two hours out for yourself, to relax and recharge. Try this! Every week, sit down and write out a schedule for yourself. In this schedule, write out study sessions for 2-3 hours at a time. Schedule in your school hours,

meditation time, exercise time, family time and “YOU” time. That’s it! You have just created a blueprint for your week. Follow it and you will be a healthy, happy and successful PA student. Good luck and remember I am always here to help. 

Attention: PA Program Directors, Class Presidents, Student Society Leaders, Faculty and Students

et CAPA know what you are doing by submitting an article and include a photo if possible. Or, you may simply send a photo with a descriptive caption. We want to let our readers know the wonderful things that are happening at our PA programs. We will print submissions on a space available basis. Send your article/photos, etc. to capa@capanet.org. Thank you!! NOVEMBER/DECEMBER 2012

Students Students Students Students Students Students Thank You to Our 2012 Student Ambassadors Molly Cobb, PA-S............................................ Touro Britta Grayman, PA-S...................................... Touro Chase Hungerford, PA-S....................................USC Latasha Johnson, PA-S............................Loma Linda Jamie McCoy, PA-S ......................................Western Mary Kate McKee, PA-S...............................Western Karen Ratcliff, PA-S .........................................Davis Saloni Swarup, PA-S ....................................Western Charlton Morgan Swinehart, PA-S ...............Western Sherry Torng, PA-S ......................................... Touro Eric Wagoner, PA-S ................................Loma Linda Cara Walker, PA-S .............................................USC Pamela Whiteley, PA-S ............................... Riverside Gai Mei Wong, PA-S....................................Western

CAPA Student Scholarships The Ruth Webb Minority Scholarship $1000 Scholarship

Ruth Webb served as program director for the Charles R. Drew University PA Program for several years, and was actively involved with numerous local, state, and national professional organizations. She was not one to sit back and let others do the work. She took a very active role doing committee work. She served as Vice Chair of the Board on Medical Quality Assurance, member of the Physician Assistant Examining Committee, member of the California Council of PA and NP programs, and founding member of the LA County Joint Practice Advisory Council on NPs and PAs. Known for “keeping it real,” she would do whatever it took to help students achieve the goal of becoming a PA-C.

CAPA NEWS

The Ray Dale Memorial Scholarship $1000 Scholarship

Ray Dale served as Executive Officer of the Physician Assistant Committee from 1980-2000, and was instrumental in the development and growth of CAPA as an organization representing our profession. Working with the Department of Consumer Affairs, he would give CAPA good counsel and support regarding legislative issues, and would help by acting as our “lobbyist” and “attorney” when CAPA could not afford one. He contributed his time and his efforts to the growth of the PA profession and protection of its consumers.

The Community Outreach Scholarship $1000 Scholarship

This scholarship will be awarded to a student who is currently in good academic standing and has demonstrated community outreach and other philanthropic activities as a student. Student Members of CAPA currently enrolled in primary care PA Programs located in the state of California are eligible to apply for CAPA scholarships. The deadline to apply for the three $1,000 CAPA Scholarships is December 31, 2012. Please visit the CAPA website for an application and for eligibility requirements.

Welcome New Members

Local Groups

July 11, 2012 through November 11, 2012 Erik Abernerthy, PA-C Kristofer Abejuela, PA-S Thadeo Aceves, PA Sakshi Aggarwal, PA-C Blossom Dawn Aguirre, PA-C Sabrina Ahmad Isabel Alegria Jennifer Aleman-Ocampo, PA-S Alicia Alexander, PA-C Ron Alforja, PA-C Farah Ali, PA-S Lindsay Ambur, PA-C Erika Amthor, PA-S Gretchen Andersen, MS, RPA-C Barbara Apicella, PA Gilbert Aragon, PA-S Michelle Ausilio, PA-S Mykhaylo Babenko, PA Robert Barker, EMT Natalie Barnes, PA-S Christina Barragar, PA-C Julia Barrett, PA-C Mara Becker, PA-S Lauren Belleville Katherine Berman, PA-C Annette Bettridge, PA-C Narek Bimanand Will Blackmon, PA-S Melissa Blake, CNA Erin Blunck, PA-C Lesly Boayes, PA-C Kelly Boeing, PA Courtney Boucher, PA-S Laura Bowman, PA-S Tanya Brosnan, PA-S Beth Brown, PA Linh Bui, PA-S Whitney Burnett, PA-S Daniel Cable, PA-C Ivy Cao, PA-S Maria Jeffervescent Caparas, PA-C Tina Carbajal, PA-C Leslie Cardoza, ATC Ann Carpenter, PA-C Aaron Carter, PA-C Matthew Case, PA-S Jacqueline Cayetano, PA-C Angela Cecil, PA-S Angela Cheung Christopher Chin, PA-S Gracee Choi, PA-S Jonathan Coniglio, PA-S Sally Conrad, PA-C Donna Cooper, PA-C Michael Cothern, PA-C Scott Cowger Eileen Crowley, PA Erin Curry Christopher Davis, PA-S Hamid Davoudi Francisco De La Parra, EMT, PA-S Allison Deane Nelae DeChurch, PA-C Christine DeGesero Jennifer DeMoss, EMT Jessica Der, PA-S Ana Sofia DeVaney, PA-S Aleece Diaz Carmelo Diaz, PA-S Beyle Dickerman Michelle Domingo, PA-S Matthew Dong, PA-C, MPH Elri Duncan, PA-S Gretchen Duran, PA-C Julie Eaker, PA-S Soha Ebneyamin, PA-S Kirt Edly, PA-C, DCM April Elliott, PA Christopher Ellis, PA-C Whitney Ellsbury, PA-S Kyle Erkkila, PA-C Aileen Estrada, PA-C Yvonne Estrada-Bazan, NP-BC Chad Eventide, PA-C Michael Feroli, PA-C

Kayla Ferrari, PA-S Lisa Few, PA-C Paola Figueroa, PA-S Robert Fontanilla, PA-S Laura Franco, PA-S Jackson Fraser, PA-C Brian Freeman, EMT Brandon Freund, PA-S Tara Futterman Catherine Gaehwiler, PA-C Christopher Gardiner Cristina Gates, PA-C Tracey Gayle, PA-C Emily Geiger Tina Gentry, PA-C Phil Gladden, PA-S, EMT Ashley Glenn-McDowell, PA-S Ana Goldberg, PA-S Veronica Gomez, PA-S Kerry Gott Mark Goya, PA-S Carlos Guerra Joyce Hacinas, PA-C Delaram Halavi, MA Nathan Hamblin, PA-S Brittany Hamilton Christina Han Ashlee Harrah, PA Lisa Harris, PA-C Nina Harris, PA-S Stephanie Hartman, PA-S Lisa Hayakawa, PA-S Benjamin Heath, PA-C Danielle Heikes, PA-C J Peter Heinen, PA-C Angela Hejna, PA-C Emily Hendrickson, PA-S Joseph Hendrix, PA-S Linda Hermann, PA-S Clarissa Hernandez, PA-C Kathryn Hernandez, PA-S Heather Herold, PA-C Benjamin Higgins, PA-S Morgan Higgins, PA-C Chelsea Hiller, PA-S Dawn Hinkle, PA-C Pierre Houbein, PA Jacey Howard, PA-C Nancy Hsieh, PA Justin Hubbarth, PA-C Linda Hudson, PA-S Laura Huettner, PA-S Craig Humes, PA-C Christopher Huntsman, MA Alexis Izumi, PA-C Mark Jacobs, PA-C Jesse Jamieson, PA-S Beata Jaron Kelly Jarvis, PA-C Kevin Jensen, PA-S Alana Johnson William Jones, MA, PA-C, DF-AAPA Karyna Karpiyevich, PA-C Saori Kato Anna Kim, PA-S Billy Kim, PA-C Jaimie Kinlaw, PA-S Christopher Kinney, MPAS, PA-C Rachel Kitson Linda Knutson, PA-C Caitlin Kogler Melissa Kollman, PA-S Vitaliy Kostyukevich, PA-C Stephanie Kowalski, PA-C Lauren Kubeck, PA-S Pamela Lachs Carie Lam Jenet Langjahr, NP Tabitha Lanning, PA-S Stacy Lasater, PA-C Wesley Lashbrook, PA-S, MPH Nora Lee, PA-S Yoonah Lee, PA-C Ebone’ LeGall, PA-S Leigh-Anne Lehrman, PA-S

Mario Lemus, PA-S Jonathan Lepp, PA Michael Levine, PA David Levy, PA-C Jun Li, PA-C Eleni Litras, PA-S Sandy Liu, PA-S Sarah LLoyd Veronica Lomeli Natalie Long, PA-S Francesca Longobardo, EMT Manuel Lorenzo, EMT, CPT Andrew Luna Shawn Luna, PA-S Madisen Ly Nathan Lycan, PA-C Elizabeth Lykins, PA-C Yolanda Magana, PA-S Ana Maldonado, PA Sherol Manavi, PA-S Fariha Mansoory John Mattera Alyssa Maurin, PA-C Charles Mayfield, PA-C Redgie McCall, PA Daniel McCarthy, PA-S Courtney McConnell, PA-S Ashley McGrogan Bob McMullen, PA-C Susan Mendes, PA-S Annelise Merriner, PA-S Stephanie Messervy, PA-C Vanessa Michelena, PA-C Megan Mier, PA-S Jason Milbert Michael Miller, PA-C Hasmik Minasian Kelly Miranda, PA-S Marco Mitchell, PA-C Neda Mojaverian, PA-S Caitlin Morgan, PA-S Peter Muchendu, PA-S Nicole Myers, PA-C Vitaliy Nebyshinets, PA-S Christina Nguyen, PA -S Phuong Nguyen, PA-C ThyVan Nguyen, PA-S Brent North, PA-C Teresa North, PA-C Hugo Noyola, PA-C Samantha Oliveira, PA-S Isaac Ortega-Endahl, PA-S Ernest Ortiz, PA-C Imade Osaghae, PA-S Tina Overstreet, PA-C Kenneth Oyadomari Christine Pagunuran, PA-S Rachel Painter, PA-S Nare Panossian, PA-C Daniel Park, PA-C Jessica Parkyn, PA-C Charmi Patel, PA-S Chrysanta Patio, PA-S Robert Paul, PA-C John Pearson, PA-C Jody Pennycook, MPA-C Kipley Pereles Alejandra Perez, PA-S Danielle Petersen, PA-S Lien Pham, PA-S Jayme Phillips, PA-S Claudia Pierola, PA Kerby Pierre-Louis, MSPAS, PA-C Ashleigh Pratt Arturo Quijano, PA-C Sarah Raike Sadaf Regar, PA-C Jody Reifenberger, PA-C Sandra Resnick Mabel Rivera, PA-S Craig Roberts, PA-C Robynn Robin-McConnell, PA-S Frances Robinson, PA-S Taylor Robinson Natalie Robles

Joshua Rodgers, PA-C Scott Rogers, PA Andres Rojas, PA-S Jorge Romo, PA-S Jeffery Rubio, PA-S Jennifer Ruckelshaus, PA-C Kristina Rusch, MPH, PA-S Marilyse Ryan, PA-C Hema Saklani, PA-S Ariana Sanchez, PA-C Ryan Saucedo Andrew Saurin, PA-S Jessica Sawyer, PA-S Justin Schmidt Mika Scott, PA-C Amit Shah, PA-S Chardonnay Shinn, PA-S Korin Shultz, PA-S Tod Sijan, PA-C Mary Evelyn Smith, PA-S Melissa Sorley, PA-C Brian Spencer, PA-C Shannon Sramek, EMT, PA-S Timothy Standon, PA-S Haley Staudt, PA-S Sharla Stauffer, MS, PA-C Kelli Streelman, PA-C Abby Stretch, PA-S Megan Strowd, PA-C Matthew Styles, PA-S Veronika Surber, PA-C Star Tahbaz Karin Tanaka, PA-S Velen Tat Serena Teddy, PA-S Emily Thach, PA-S, AT-C Michaela Thomas Jami Tipre, MPAP, PA-C Spencer Townsend, PA-C Brian Tran, PA-S Doreena Tran Kay Tran, PA-S Judy Truong, PA-S Theresa Tsingis, PA-S, D.C., M.S. Wendi Tsukada, PA-S Darryl Turner, PA-S Hector Urquilla, PA-S Marina Vaca, PA-S Corena Valencia-McBride Steve Van Patten, PA-C Behrang Vessali Kevin Vida, PA-C Frederick Vinton, PA-C Thuy Vo, PA-S Anh Vu Quynh Vu, PA-S Julie (Heu) Vuong, PA-C Rachel Wang, MA Vanessa Wang, PA-C Gayle Warneke, PA-S Allyson Way, PA-S Alanda Weber, PA-S Ashleigh Westfall, PA-S Sarah Whitaker, PA-C Jaimie White, PA-C Danae Wilke, PA-S Aaron Willcott, PA-C Chris Williams, PA-S Brandon Winkles, PA-S Carol Wolcott, PA-S David Wolf, PA-S Brian Wolter, PA-S Sara Woodruff, PA-C Cybel Wu, PA-S Shermin Yaghoubi, PA-S Doreen Yasharel, PA-S Tseng Mei Yip, PA-S Michael Zamora, PA-S Gabriel Zapata, PA-S

1. Redding Area PA/NP Alliance Summer Ross, PA-C; (530) 275-5747 summerross@hughes.net 2. Physician Assistant Society of Sacramento (PASS) Carlos De Villa, PA-C, PASS President; (916) 973-6185, pasocietyofsac@yahoo.com Atul Sharma, PA-C, MMS, MPH, CHES; (916) 397-6035, pasocietyofsac@yahoo.com 3. Contra Costa Clinicians Association Brian Costello, PA-C; (707) 651-2705, contracostapas.com 4. San Francisco Bay Area Physician Assistants (SFBAPA) www.sfbapa.com, PO Box 14096, San Francisco, CA 94114-0096 Martin Kramer, PA-C; (415) 433-5359, Fax: (415) 397-6805, mkramersf@hotmail.com 5. Bay Area Mid-Level Practitioners Rose Abendroth, PA-C; (650) 697-3583, Fax: (650) 692-6251, rosepard@aol.com Matt Dillon, PA-C; (650) 591-6601, mattdillon42@hotmail.com 6. Bay Area Non-Docs Linda O’Keeffe, PA-C; (650) 366-2050, lindapac@aol.com 7. Northcoast Association of Advanced Practice Clinicians John Coleman, PA-C; (707) 845-6008, streetdrag49@sbcglobal.net 8. Stanislaus County NP/PA Network Brian Cormier, PA-C; (209) 605-4966, briancor@verizon.net, www.nppanetwork.org 9. Stockton Midlevels Emma Calvert, PA-C; stocktonmidlevels@gmail.com 10. Journal Club for PAs and NPs (Fresno area) Cristina Lopez, PA-C; (559) 875-4060; Fax: (559) 875-3434, clopez875@aol.com; 2134 10th St, Sanger, CA 93657 11. Central Coast Nurse Practitioners & Physician Assistants Kris Dillworth, NP; ccnppa@yahoo.com Sharon Girard, PA-C; (305) 803-1560; ccnppa@yahoo.com 12. So Cal PAs Linda Aghakhanian, PA-C; want2heal@hotmail.com 13. Orange County Hung Nguyen, PA-C; (714) 846-8178; nhy52@yahoo.com 14. San Gabriel Valley Local Group M. Rachel DuBria, PA-C; (818) 744-6159, racheldca@aol.com 15. San Fernando/Santa Clarita Valley Group Jonah Tan, MPT, PA-C; (818) 634-0007, jotptpa@yahoo.com 16. Coachella Valley Physician Assistant Group Matthew Keane, MS, PA-C; mkeanepas@gmail.com 17. San Diego Area Jeremy Adler, MS, PA-C; (619) 829-1430, jadler@simplyweb.net

NOVEMBER/DECEMBER 2012

California Academy of Physician Assistants 2318 S. Fairview St. Santa Ana, CA 92704-4938

PRSRT STD US POSTAGE PAID SANTA ANA, CA PERMIT NO 949

Address Service Requested

One-Day Conference in Napa at the Napa Valley 6 Hours of Cat. I CME

CAPA at Napa Saturday, February 23, 2013 8:45 a.m. - 4:15 p.m. Register online at www.capanet.org